利用微信平台延续性护理对老年腰椎间盘突出症术后患者康复及生活质量的影响

目的探讨微信平台延续性护理对老年腰椎间盘突出症术后患者康复及生活质量的影响。方法选取2015年6月—2018年5月在郑州市骨科医院接受手术治疗的老年腰椎间盘突出症患者96例进行研究。对照组行常规延续性护理,观察组行微信平台延续性护理。对比两组康复效果、治疗依从性及生活质量。计数资料采用卡方检验分析,计量资料采用t检验分析。结果观察组有效率为95.83%,明显高于对照组的81.25%。观察组总依从率为91.67%,明显高于对照组的77.08%。干预前两组生活质量量表得分相当,治疗后两组生活质量均有明显改善,但观察组改善程度更为明显。结论微信平台延续性护理相比传统延续性护理可明显提高老年腰椎间盘突出症患者康复效果、提高治疗依从性和改善生活质量。     

小角度弯曲针法介入治疗腰5-骶1椎间盘突出症

目的探讨小角度弯曲针穿刺法进行腰5-骶1椎间盘或低位腰4~5椎间盘介入治疗的方法和应用效果。方法对50例明显低于髂嵴的腰4-5或腰5-骶1椎间盘突出症患者采取小角度弯曲针法穿刺椎间盘进行介入治疗。透视下旋转血管机的C型臂,使射线方向与椎间隙平行,将皮肤穿刺点位于距离脊柱中线6~8cm处,常规消毒麻醉;将穿刺针的前端2~3cm向一侧弯曲20°后向椎间盘穿刺,侧位观察接近椎间盘后缘时,将穿刺针弯曲端偏向内侧、上方进入椎间盘后外侧部,然后进行椎间盘内臭氧注射或等离子消融治疗。结果椎间盘穿刺顺利,一次穿刺成功者45例,占90%,穿刺针进入椎间隙后多数与椎间隙平行,利于盘内介入操作(40/50,占80%),仅20%穿刺后针尖位置欠理想,但尚可完成臭氧注射溶核。经穿刺针向盘内注射臭氧分布良好,等离子刀头活动范围适合消融需要,手术后近期有效率96%,无明显穿刺并发症。结论小角度弯曲针法可以避免高位髂嵴对低位椎间盘穿刺的限制,提高穿刺针在椎间盘内的位置精度,有利于顺利施行介入处理,减少穿刺损伤,缩短手术时间。     

Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up

BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.     

颞颌关节不可复性盘前移位上腔造影与关节腔冲洗的临床应用

目的 通过TMJ上腔造影，结合关节腔冲洗、注药及术后下颌磨牙区牙合垫治疗不可复性盘前移位。方法 根据病史结合临床症状选取38例患者，其中单纯性不可复性盘前移位患者15例，合并滑膜炎表现23例。按常规进行关节上腔造影术后拍摄数字化TMJ开闭口断层片、开口度检查，部分患者使用生理盐水进行关节腔冲洗。冲洗后根据病情，关节腔内注入强地松龙或透明质酸钠，注药后再次测量开口度。结果 不可复关节盘移位开口度及髁突侧向运动度明显增加。合并滑膜炎者疼痛症状减轻。结论 TMJ关节上腔造影结合关节腔冲洗注药及He垫治疗，可明显增加开口度、髁突运动度。减轻关节疼痛。因此，是一种治疗早期不可复性盘前移位的有效方法。     

胸腰段椎间盘突出症诊断的临床研究

目的探讨胸腰段椎间盘突出症临床表现的特点与规律，提高胸腰段椎间盘突出症的诊断水平。方法回顾性分析1995年9月～2004年1月我院经X线、CT、MRI及手术证实的胸腰段椎间盘突出症65例的临床资料，并将其分为低位胸椎组（T10-T12L1）43例，高位腰椎组（L1-2-L2-3）16例，多节段突出组6例。结果躯体感觉障碍89．2％（58／65）和下肢无力83．1％（54／65）是最多见的症状。9．2％（6／65）表现为上运动神经元损害，47．7％（31／65）表现为下运动神经元损害，43．1％（28／65）表现为上、下运动神经元混合性损害。仅3例为单根神经根损害，其余表现为多根神经或马尾神经的损害。腰背痛44．6％（29／65）和下肢无力40．0％（26／65）是最常见的首发症状。低位胸椎间盘突出以混合性运动神经元损害为主，占58．1％（25／43），易导致行走障碍、足下垂、下肢肌张力升高和病理征阳性；而高位腰椎间盘突出则以下运动神经元损害为主，占93．8％（15／16），易造成腰背、下肢疼痛及马尾神经损害。结论胸腰段椎间盘突出症的症状广泛、体征多样，当临床上存在以下情况时应高度怀疑胸腰段椎间盘突出症：①大腿前方、外侧或腹股沟部位出现感觉障碍者；②下肢无力，股四头肌，胫前肌肌力减退者（如足下垂）；③下肢运动或感觉障碍范围广泛、不规则，缺乏根性分布特征者；④上、下运动神经元损害同时存在，或虽表现为下运动神经元损害，但难以用低位腰椎间盘突出症解释者。     

脊椎滑脱症合并腰椎间盘突出的治疗

1987年6月至1995年1月我院共治疗脊椎滑脱55例,其中17例合并腰椎间盘突出,占31％,临床表现为顽固的腰骶痛和下肢根性放射痛。手术复位、融合不稳定脊椎的同时,均摘除突出的椎间盘髓核组织。经半年以上随访,疗效满意,作者分析了本病的病因病理,认为诊断该病必须综合性检查分析,脊髓造影或CT检查有一定影像学诊断价值,治疗宜早行探查手术。     

压迫及非压迫因素在实验性神经根性疼痛中的作用

目的：探讨压迫及非压迫因素在实验性椎间盘源性神经根性疼痛中的作用。方法：取大鼠白体脊椎关节突修剪后放置在L5神经根下．造成对L5神经根的直接压迫（压迫组）；取大鼠白体尾椎椎间盘组织无压迫下放置在L5神经根表面（非压迫组）：同时设立对照组。术后不同时间点测定各组大鼠后足底机械刺激疼痛阈值的变化。结果：压迫组与非压迫组大鼠后足底均产生了一个长时程机械刺激疼痛阈值的降低；与压迫组相比．非压迫组大鼠术后1天就开始出现了疼痛阈值降低（P〈0．05），明显早于压迫组大鼠，并且疼痛阈值降低更加显著：而压迫组大鼠术后1周时才出现明显的疼痛阈值降低（P〈0．05）。对照组大鼠疼痛阈值没有发生明显的改变。结论：尽管压迫和非压迫因素都参与椎间盘源性神经根性疼痛的发生．但二者作用的时间不同＋在椎间盘突出的早期阶段非压迫因素可能在疼痛中起着重要的作用：随后压迫因素可能逐渐成为致痛的主因。     

电针加委中刺血治疗急性腰椎间盘突出症

目的:探寻治疗急性腰椎间盘突出症的较佳疗法.方法:将100例患者随机分为两组.观察组52例,采用电针疗法,穴取腰阳关、大肠俞、关元俞、小肠俞为主,结合委中附近瘀络刺血治疗;对照组48例,采用牵引配合电针,穴取夹脊穴、肾俞、大肠俞为主,观察两组疗效并进行比较.结果:观察组治愈率为55.8%,愈显率为82.7%,对照组分别33.3%、54.2%,组间差异均有统计学意义(P＜0.05,P＜0.01).结论:电针结合委中附近瘀络刺血治疗急性腰椎间盘突出症疗效显著.     

一期后、前路手术治疗发育性颈椎管狭窄症合并巨大椎间盘突出

目的：评价一期后、前路手术治疗发育性颈椎管狭窄合并巨大椎间盘突出的特点及疗效。方法：回顾分析2002年2月至2006年1月接受该术式的21例患者的临床资料,对手术前后临床表现、JOA评分、MRI影像变化以及术后神经功能改善率及并发症进行总结分析。结果：术后未发生神经系统症状加重、感染及内固定失效等并发症。获得1年以上随访者21例,平均随访时间为29.2个月,术后3个月、12个月时神经功能改善率分别为：58%、66%;16例获得2年以上随访者神经功能改善率为71%。结论：一期后、前路手术治疗发育性颈椎管狭窄合并巨大椎间盘突出可缩短治疗周期,相对节省治疗费用,同时解除了硬膜囊前、后方的压迫,减压彻底,疗效满意。     

Contrast on T2-weighted images of the lumbar spine using fast spin-echo and gated conventional spin-echo sequences

A prospective study in 31 patients was designed to compare contrast quantitatively using axial conventional, gated spin-echo T2-weighted (T2W) (SE) (asymmetrical echo TE 30 and 80 ms) and axial dual-echo fast spin-echo (FSE) sequences (TE_eff20 and 120 ms) to image lumbar discs, nerve roots, and cerebrospinal fluid CSF. We used two quantitative measures, percent (%) contrast and contrast-to-noise ratio (CNR), to compare the sequences. The FSE sequence had greater % contrast and CNR on the first and second echo images for both disc and nerve root detection using these scan parameters. An axial FSE sequence, therefore, provided contrast characteristics similar to those of gated axial T2W SE sequence in the lumbar spine, with a 60% saving in acquisition time. The FSE sequence is now our standard axial T2W study for the lumbar spine.